The Minister of State and I have had many debates over the years on mental health and dual diagnosis. The very first legislation I introduced here in 2021 was the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill. I introduced it because working in mental health and addiction services I saw the real need for that. I understand 100% why Deputy Clarke is looking to have this enshrined in the Bill because I fear if that is not done and this is not given the parity of esteem it needs, it could fall between the cracks. Vulnerable people who have addiction and substance misuse issues along with mental health issues often fall through the cracks. When I was working in front-line services, I was working in an addiction service. Right across the road there was a mental health service. People were trying to access both services and were being sent away from the addiction services because staff in those services did not have the training and understanding of how to deal with mental health issues. People were going across to the mental health services and being told to go look after their addiction issue and then come back, so they were falling between the cracks. What often happens then is a community response takes place because the community has to evolve and respond to what is going on in that community. That is what happened there. The community responded by setting up a cross-departmental working group between the two services. It just evolved over time and it really works. I have one question and the Minister of State might be able to come back to me on it. I am a bit concerned about her mentioning how this could be put in via secondary legislation. How long has this legislation taken to get to the Stage it is at? Secondary legislation could be another way of kicking this down the road. Dual diagnosis could be put on the long finger and not dealt with. Does she have a timeframe for that secondary legislation and when we would see anything like that implemented?
Sentiment score: -0.06
I appreciate the work that has been done by the Minister of State and the HSE in reducing the number of young people who have been admitted into adult psychiatric facilities under her tenure. It is acknowledged and it has worked but, as she knows, I always say that we should set the bar high. Let us aim for zero because that is what we should be aiming for. I am not questioning the Minister of State's bona fides in relation to the five people who were admitted last year. They had the consent of their parents and they were all 17 years of age, but that was not always the case. That is my concern. Because it was not always the case, it could happen again. We have had debates here previously on instances where young people were in adult facilities for weeks on end. That was very early in the Minister of State's tenure, but it was happening. I am not sure whether they all had the consent of their parents for being in there either. I am very disappointed that Deputy Clarke's amendment was ruled out of order for a money reason.
Sentiment score: 0.03
It was ruled out of order for the money rule. I find that really disappointing. My concern is that because it has happened in the past, it could happen again. I appreciate that the Minister of State has done an awful lot of work on it over the last while. I wonder what safeguards we could have in place. If there is no appropriate facility where a child can access the appropriate mental health care, it is not a failure in legislation; it is a failure in service provision. That is where the failure comes in. This legislation is papering over the cracks of the service provision that is there when it comes to appropriate mental health care. I would like to know what safeguards will be in place to stop what was happening in the past when young people were in adult psychiatric facilities, sometimes for weeks on end.
Sentiment score: 0.10
For too long, members of An Garda Síochána have been the gatekeepers for mental health services. When I speak to gardaí in my constituency, which I do on a regular basis, one of the issues they raise is when people arrive at the station under mental duress and they try to help them. A psychiatrist will sometimes come out to a Garda station and may or may not make a decision as to whether the person needs to be involuntarily detained. More often that not, people are not detained and are sent back out into the community where the gardaí will encounter them at a later time. I welcome the pilot project in Limerick, which witnesses before the health committee spoke about earlier today. It is a good initiative that can curb some of the problems we are discussing. I would like to see it rolled out across the State. Our amendment makes provision for a code of practice for staff working in registered acute mental health centres, gardaí, HSE authorised personnel, GPs and anybody else involved in the provisions of this section. The development of such a code of practice would be really welcome as it would give guidelines to people - especially gardaí, who are sometimes at a loss - on how to work with persons who are under mental duress. I know some gardaí who have undertaken specific training to help them deal with these types of situations, but such training is not mandatory and is not always made available. I remember the first time I had gardaí taking part in the applied suicide intervention skills training, ASIST, programme I was delivering, which helps people to identify the signs of suicidal feelings. Gardaí do that training on a voluntary basis to get an insight into how people get to the stage where they are under mental health duress. Such engagement is always welcome. A code of practice that sets out guidelines for helping people in that situation should be in place.
Sentiment score: 0.13
I would have been all over this Bill had it been brought before the House last year, when I was still the spokesperson on mental health. I will ask a question and I presume it is in this Bill because it is about involuntary admissions and the lacuna as regards the Assisted Decision-Making (Capacity) Act. If the Minister of State remembers correctly, there was a lacuna between that Act and this Bill whereby the only people who were excluded from making advance healthcare directives were people who were involuntarily detained under the Mental Health Act. I know I am reaching a little here, but does this overall Bill breach that lacuna? Does it answer any questions that that lacuna created? I will use myself as an example. As the Minister of State knows, I have a neurological condition. I have spoken about it regularly enough. I have the ability to make an advance healthcare directive as to how I would like my future healthcare to be rolled out as I get older. It is something I keep saying I will do but I have not done, but I can do that. As regards somebody who has been involuntarily detained, I have met a number of people and have spoken about this in the media a number of times. For example, if they would have received ECT treatment when they were involuntarily detained in the past, that is something they would not like to see again if they had to go into a psychiatric facility. However, they do not have the ability to make that decision under the Assisted Decision-Making (Capacity) Act and this Bill. There was a lacuna between the two Bills. Has that lacuna been breached or have we managed to resolve it in this Bill? The reason I ask is that I just do not know, to be honest.
Sentiment score: 0.01